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Based on review of clinical records, Facility policies and procedures and interview, it was determined nursing staff failed to update care plans to include skin integrity when Braden scores were 16 or less in 6 (#1, 2, 5, 7, 9, 12) of 15 (#1-15) records reviewed. The failed practice did not assure care plans included risk assessment for skin breakdown; did not assure goals were established to prevent or treat skin breakdown; and did not assure communication between nursing shifts addressed skin integrity and had the likelihood to affect all patients admitted to the facility. Findings follow:

A. Review of Policy "Interdisciplinary Plan of Care - System Wide" presented by the Quality Coordinator on 02/13/14 at 0915 revealed, the patient's plan of care must be updated and current according to condition changes and reassessments.

B. Review of Policy, "Wound/Skin Management - Impaired Skin Integrity - Prevention" presented by the Quality Coordinator on 02/13/14 at 0915 revealed, Braden risk score less than or equal to 16, initiate plan of care. a. Patients with no impaired skin integrity, initiate risk for impaired skin integrity plan of care. b. Patients with impaired skin integrity, initiate impaired skin integrity plan of care.

C. Review of nursing assessments for Patient #1 revealed the following:
1) On 01/21/14 at 1200 Braden score was 15. There was no evidence skin integrity was included in the care plan.
2) On 01/22/14 at 0900 Braden score was 16. There was no evidence skin integrity was included in the care plan.
3) On 01/28/14 at 0953 Braden score was 16. There was no evidence skin integrity was included in the care plan.
4) On 01/29/14 at 1216 Braden score was 15. There was no evidence skin integrity was included in the care plan.
5) On 01/30/14 at 1004 Braden score was 15. There was no evidence skin integrity was included in the care plan.
6) On 01/31/14 at 0905 Braden score was 14. There was no evidence skin integrity was included in the care plan.
7) On 02/01/14 at 0958 Braden score was 16. There was no evidence skin integrity was included in the care plan.
8) On 02/02/14 at 1507 Braden score was 15. There was no evidence skin integrity was included in the care plan.

D. Review of nursing assessments for Patient #2 revealed the following:
1) On 02/01/14 at 1600 Braden score was 9. There was no evidence skin integrity was included in the care plan.
2) On 02/02/14 at 0800 Braden score was 8. There was no evidence skin integrity was included in the care plan.
3) On 02/03/14 at 0815 Braden score was 12. There was no evidence skin integrity was included in the care plan.
4) On 02/04/14 at 0916 Braden score was 14. There was no evidence skin integrity was included in the care plan.
5) On 02/05/14 at 0927 Braden score was 14. There was no evidence skin integrity was included in the care plan.
6) On 02/06/14 at 0800 Braden score was 14. There was no evidence skin integrity was included in the care plan.
7) On 02/07/14 at 0905 Braden score was 14. There was no evidence skin integrity was included in the care plan.
8) On 02/08/14 at 0900 Braden score was 15. There was no evidence skin integrity was included in the care plan.
9) On 02/09/14 at 1900 Braden score was 11. There was no evidence skin integrity was included in the care plan.
10) On 02/10/14 at 0819 Braden score was 12. There was no evidence skin integrity was included in the care plan.

E. Review of nursing assessments for Patient #5 revealed the following:
1) On 01/27/14 at 0930 Braden score was 14. There was no evidence skin integrity was included in the care plan.
2) On 01/28/14 at 1516 Braden score was 9. There was no evidence skin integrity was included in the care plan.
3) On 01/29/14 at 1028 Braden score was 13. There was no evidence skin integrity was included in the care plan.
4) On 01/30/14 at 0900 Braden score was 15. There was no evidence skin integrity was included in the care plan.
5) On 01/31/14 at 0941 Braden score was 14. There was no evidence skin integrity was included in the care plan.
6) On 02/01/14 at 1236 Braden score was 16. There was no evidence skin integrity was included in the care plan.
7) On 02/03/14 at 0751 Braden score was 9. There was no evidence skin integrity was included in the care plan.
8) On 02/04/14 at 0800 Braden score was 16. There was no evidence skin integrity was included in the care plan.
9) On 02/05/14 at 0800 Braden score was 15. There was no evidence skin integrity was included in the care plan.
10) On 02/06/14 at 0853 Braden score was 13. There was no evidence skin integrity was included in the care plan.
11) On 02/07/14 at 0841 Braden score was 9. There was no evidence skin integrity was included in the care plan.
12) On 02/09/14 at 0800 Braden score was 14. There was no evidence skin integrity was included in the care plan.
13) On 02/10/14 at 1053 Braden score was 16. There was no evidence skin integrity was included in the care plan.
14) On 02/12/14 at 1949 Braden score was 12. There was no evidence skin integrity was included in the care plan.

F. Review of nursing assessments for Patient #7 revealed the following:
1) On 02/11/14 at 1400 Braden score was 14. There was no evidence skin integrity was included in the care plan.
2) On 02/12/14 at 2000 Braden score was 13. There was no evidence skin integrity was included in the care plan.

G. Review of nursing assessments for Patient #9 revealed the following:
1) On 02/11/14 at 0103 Braden score was 16. There was no evidence skin integrity was included in the care plan.
2) On 02/12/14 at 1000 Braden score was 16. There was no evidence skin integrity was included in the care plan.

H. Review of nursing assessments for Patient #12 revealed the following:
1) On 01/16/14 at 0900 Braden score was 16. There was no evidence skin integrity was included in the care plan.
2) On 01/17/14 at 0823 Braden score was 16. There was no evidence skin integrity was included in the care plan.
3) On 01/18/14 at 0935 Braden score was 16. There was no evidence skin integrity was included in the care plan.
4) On 01/20/14 at 0910 Braden score was 15. There was no evidence skin integrity was included in the care plan.

I. During interview 02/13/14 at 1435, findings were verified with the Manager of the Intensive Care Unit.